SURGICAL TREATMENT OF MALIGNANT TUMOURS OF THE STOMACH, COMPLICATED BY GASTROINTESTINAL BLEEDING

Abstract

Summary. Objective. The main aim of this study is to optimise the surgical treatment of patients with gastric malignancies complicated by gastrointestinal bleeding, to develop and implement new treatment tactics in clinical practice.Materials and methods. The study was conducted on the basis of the Kyiv City Centre for Emergency Medical Care for Patients with Gastrointestinal Bleeding and the Kyiv City Clinical Emergency Hospital (Ukraine) in the period from 2010 to 2020. A comprehensive examination and analysis of the results of treatment of 140 patients with gastric malignancies complicated by acute gastrointestinal bleeding was performed, which accounted for 2.2% of all patients with gastrointestinal bleeding during this period. Results. Radical surgery was performed in 97 (69.3 %) patients, palliative and symptomatic surgery — in 43 (30.7 %). Radical surgeries were performed at stage I and Cr in situ in 19 (13.6 %), stage II — 48 (34.3 %), stage III — 45 (32.1 %), stage IV — 28 (20.0 %). In an emergency procedure, 19 (13.6%) patients were operated on at the height of ongoing bleeding and at the height of its recurrence with a mortality rate of 5.3% (1 patient): 17 radically (89.5 %), 2 (10.5 %) — non-radically. In the early delayed period, after adequate preoperative preparation and comprehensive examination, 121 (86.4%) patients were operated on, of whom 80 patients underwent radical surgery. The overall postoperative mortality rate was 7.1% (10 patients), and 6 (4.3%) patients died after radical surgery 6 (4.3%) patients died after radical surgery, and 4 (2.9%) patients died after palliative and symptomatic surgery. The five-year survival rate after radical surgery was 44.5%, and the 10-year survival rate was 8.9%, with an average life expectancy of 29 months. Conclusions. Operations at the height of ongoing bleeding in patients with gastric malignancies are very dangerous due to high postoperative mortality. The optimal standard is the use of a complex of minimally invasive methods of endosurgical haemostasis to stop active bleeding and prevent its recurrence and to operate on patients in the early delayed period. Adherence to such tactics is advisable in terms of reducing the risk to the patient's life and the possibility of radical surgery.